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Objective:To evaluate the clinical effect of the pulmonary rehabilitation system based on the concept of prehabilitation for patients after cardiac surgery to wean tube and avoid related complications.Methods:From January 2018 to December 2019 in a single-center(third-class hospital in cardiac surgery intensive care unit), all adult patients hospitalized for 7 days before open-heart surgery were included. They were randomly divided into pulmonary rehabilitation group(198 cases) and control group(234 cases). To compare and analyze the clinical effects, the main observations were observed including overall outcome indicators(such as early extubation rate, ICU stay, hospitalization costs, advanced oxygen therapy support after extubation) and lung outcome related indicators(such as the occurrence of pulmonary complications, chest drainage, secondary intubation, tracheotomy, lung infection and chest tube drainage).Results:There was no statistical difference between groups in basic conditions and surgical conditions. The lung rehabilitation group significantly increased the rate of early extubation, reduced the number of advanced oxygen therapy after weaning, shortened the length of ICU stay, saved hospitalization cost, significantly reduced the occurrence of postoperative respiratory complications and improved postoperative respiratory function( P<0.05). Conclusion:During cardiac perioperation, pulmonary rehabilitation significantly can increase the rate of early extubation , shorten the length of mechanical ventilation, reduce the occurrence of secondary tracheal intubation and pulmonary complications. And it can also effectively promote the recovery of lung function and the overall recovery.
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Objective:To understand the current status of nurses' awareness and needs for the Employee Assistance Program (EAP), as to provide basis for the hospital to formulate EAP.Methods:Using the purpose sampling method, 352 ICU nurses from the Nanjing Drum Tower Hospital Affiliated of Nanjing University Medical School were selected as the research subjects from December 2019 to January 2020. Finally, 350 valid questionnaires were obtained. Use the EAP demand questionnaire to investigate the ICU nurses' awareness and demand for EAP.Results:Among the 350 nurses in the intensive unit, 214 cases (61.14%) had never understood EAP, only 8 (2.29%) had understood and experienced the EAP, and 332 cases (94.86%) believed that the hospital′s implementation of EAP was a benefit provided to nurses. The top two service requirements were: "Relief of work pressure" and "mental health consultation", and hope to receive mixed-mode EAP services; in ICU and CCU, nurses hope EAP can help resolve work-family conflicts; in EICU, they need to provide Specific job skills training services.Conclusions:ICU nurses have insufficient cognition of EAP and urgently need to obtain EAP implementation knowledge; at the same time, it is necessary to formulate an implementation plan that meets ICU nurses′ needs for EAP, that is, to relieve work pressure and carry out psychological counseling to ensure that EAP is launch successfully in ICU nurses.
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Objective:To summarize the nursing experience of 7 cases of "zero blood transfusion" type A acute aortic dissection during the perioperative period.Methods:Preoperative risk assessment, control of heart rate, blood pressure, analgesia and sedation to avoid dissection;fully keep warm during operation and recover blood from operation field;after operation, avoid heart rate and blood pressure fluctuations to reduce oozing, monitor coagulation indicators, observe the amount and characteristics of drainage fluid, ensure the safety of anticoagulation during Renal replacement therapy, and avoid blood waste.Results:The 7 patients all transitioned to the operation smoothly. Intraoperative and postoperative infusion of pre-storage and recovery autologous blood of 200-1 200 ml, no allogeneic blood transfusion. One patient had a lot of drainage after surgery. The drainage volume was 1 450 ml on the day and the first day. He was given autologous blood infusion combined with hemostatic drugs, and the hemoglobin could be maintained above 80 g/L; 2 patients complicated with hypoxemia, were sequential High-flow oxygen; 2 patients with acute kidney injury underwent continuous renal replacement therapy without unplanned dismissal. All 7 patients recovered and were discharged after active treatment.Conclusions:For patients with type A acute aortic dissection surgery, through careful blood protection care, you can reduce dependence on allogeneic blood.